Challenges and opportunities for inclusive and sustainable WASH

Great strides have been made in improving sanitation in many developing countries, not least through CLTS, an innovative method developed to address the behaviours behind ongoing open defecation. CLTS has spread rapidly over the last 16 years and is now present in over 60 different countries. However recent research shows that more thinking and action is needed to ensure that sanitation efforts are sustainable and inclusive. A new book, entitled Sustainable Sanitation for All[2], examines how CLTS and the WASH sector more generally has and needs to continue to evolve to meet these challenges.

The urgency of the sanitation crisis cannot be underestimated. An estimated 2.4 billion people worldwide still lack access to adequate facilities, of whom 1 billion defecate outdoors. Faecally transmitted infections, poverty, and undernutrition reinforce each other.

In December 2015, a UN General Assembly resolution defined water and sanitation as two separate rights for the first time while the Sustainable Development Goals (SDGs) include the ambitious aim of universal access to improved sanitation by 2030, with targets that include the elimination of open defecation.

The achievement of open defecation free (ODF) status is increasingly being recognised as only the first stage in a long process of change towards Total Sanitation.

“Open defecation free is just a start, we need to maintain the gains, deal with the faecal sludge, resolve problems of menstrual and hand hygiene, and see sanitation businesses spread around the world.” Professor Val Curtis, Director of Environment Health Group at the London School of Hygiene & Tropical Medicine.

New book “Sustainable Sanitation for All” looks beyond open defecation free

With a particular focus on sustainability of behaviour change as well as physical infrastructure, post-ODF follow up and monitoring, and ensuring equity and inclusion, Sustainable Sanitation for All includes 18 contributions which look at cases from Asia and sub-Saharan Africa. Edited by Petra Bongartz, Naomi Vernon and John Fox, the book was produced by the CLTS Knowledge Hub, based at IDS and published by Practical Action.

Exploring current experiences, innovations and insights, the book addresses two key questions:

How do we reach the poorest and most marginalized, with toilets that are suitable to their needs?

How can we embed hygienic habits and create new social norms around sanitation behaviour?

In his foreword to the book, Robert Chambers writes, “The empirical evidence and analysis in the eighteen contributions made in this book show just how much has been learned. We have learned that without losing its core essence, CLTS must be adapted and evolved to fit national and local conditions.”

One-day meeting brings water and sanitation experts together on how to take forward and expand on CLTS

On 23 November, the CLTS Knowledge Hub brought together over 20 experts on sanitation (CLTS and WASH) to discuss the challenges and opportunities for making sanitation sustainable and inclusive and to elicit views on how to better meet the needs of the sector through its activities.

Diversity of contexts requires adaptable and pluralistic approaches

The huge diversity in contexts within which CLTS has been used suggests that the traditional approach needs to be adaptable to respond to different needs. The range of different experiences to learn from is much wider than it was just 5 years ago. There are now opportunities for pluralism and with that more openness and learning.

Inclusion needs to remain at the forefront of efforts to sustain ODF communities

When done badly, CLTS has been known to exacerbate existing inequalities. Whilst in an ideal case scenario, the poor or less able are helped by the better off, in practice, this is often not the case. Since the poor and less able people find it the most challenging to access and sustain adequate sanitation facilities and bear the highest burden of disease it is imperative that better ways of reaching them and meeting their specific needs are found.

Do subsidies need to be revisited?

Whilst CLTS has always maintained a strong position against individual household hardware subsidies, it may now be time to look at how smart financing mechanisms could support efforts to make sanitation more inclusive.

In many cases, maintaining a position against subsidies is the right thing to do, in order to achieve the behaviour changes needed to achieve ODF. However, many present at the meeting agreed that a more nuanced and targeted approach to subsidies, for example through a voucher or rebate systems as described by Andy Robinson’s book chapter, may add value.

Sanitation Marketing

We have come a long way since some of the early meetings and discussions when CLTS and sanitation marketing were presented as opposing approaches with practitioners aligning themselves to the different camps. Now there is a far more nuanced understanding and discussions are evolving around ways CLTS and sanitation marketing can complement each other and be phased together to ensure sustainable ODF communities.

Handwashing CLTS must be better linked together with other sanitation and hygiene concerns. One crucial area that was identified as a frontier we have yet to crack was handwashing. It is clear that more innovation is needed in order to influence handwashing behaviour in communities.